Answer the questions of study guide 1 and 2 using Brunner & Suddarth’s Textbook of Medical-Surgical Nursing as the source.
Study Guide 1
Fluid & Electrolyte Unit
Chapter 10 ? Fluid & Electrolytes: Balance & Disturbance
1. What is third spacing?
b. What are some common causes and symptoms that are seen when this occurs in the body?
2. Need to know the normal ranges for: K, Na, Cl, Ca, Phos, Mag.
3. What are some signs & symptoms of fluid volume deficit?
b. What is the recommended treatment for patients who are fluid volume deficient?
4. What are some signs & symptoms of fluid volume excess?
b. Fluid volume excess can lead to which complications?
c. Patients with which medical conditions are most at risk for fluid volume excess?
5. Compare & contrast risk factors, assessment findings, and nursing care for hypo & hypr:
a. Sodium
b. Potassium
c. Calcium
d. Magnesium
e. Phosphorus
6. We are most concerned with the cardiac abnormalities & arrhythmias that usually occur when there is an imbalance in which electrolyte?
7. Use of which frequently used class of medication puts patients at risk for hypokalemia?
b. Is there a way to prevent this?
c. If so, how?
8. A patient would present with a positive Chvostek & Trousseau sign if they were deficient in which two electrolytes?
9. Due to muscle weakness, parasthesias, & reflex abnormalities that can occur in the presence of many various electrolyte imbalances, these patients should be placed on which types of precautions while hospitalized?
10. Name some foods that are high in the electrolytes listed below, which should be recommended for patients who are deficient in these electrolytes:
a. Sodium
b. Potassium
c. Calcium
d. Magnesium
e. Phosphorus
11. What are normal pH, bicarbonate (HCO3), and PaCO2 levels?
12. ?Metabolic? acidosis or alkalosis is seen when there is an imbalance in the pH & ___________.
13. ?Respiratory? acidosis or alkalosis is seen when there is an imbalance in the pH & __________.
study guide 2
Text: Brunner and Suddarth
Learning Objective #1: Explain the function of the kidneys in regulating fluids, electrolyte balance, acid?base balance, blood pressure, RBC production, and Vitamin D synthesis.
a. What are the main functions of the kidneys?
b. During urine formation, which two substances should be reabsorbed and not excreted in the urine?
c. What two major electrolytes do the kidneys help regulate?
d. What is the role of the kidneys in maintaining serum pH through bicarbonate?
e. Explain the renin-angiotensin system in regulating blood pressure, including the roles of anti-diuretic hormone and aldosterone in this system.
f. How do the kidneys contribute to RBC production?
g. How do the kidneys contribute to Vitamin D synthesis?
Learning Objective #2: Explain the renal system changes and nursing implications for older people.
Learning Objective #3: Initiate education, preparation, and monitoring for patients undergoing diagnostic studies, including labs, 24-hour urine collection, any that use contrast media, and kidney biopsy.
a. What are the normal ranges for urine specific gravity, creatinine clearance, serum creatinine, serum BUN, and GFR?
b. What is the significance of abnormal values of urine specific gravity, creatinine clearance, serum creatinine, BUN, and GFR in kidney disorders?
c. What is the purpose and proper collection steps for a 24-hour urine collection?
d. What are the pre-, intra-, and post-procedure interventions and rationales for a patient who will receive intravenous contrast media during a diagnostic test?
Brunner and Suddarth Chapter 48
Learning Objective #1: Differentiate between chronic kidney disease (CKD) and acute kidney injury (AKI).
a. What is the definition and diagnostic criteria of AKI?
b. What are the categories and causes associated with each category for AKI?
c. What is the definition of CKD?
d. What are the risk factors and causes of CKD?
Learning Objective #2: Explain the pathophysiology, clinical manifestations, medical management, and nursing management for patients with acute kidney injury.
a. Identify and describe the phases of AKI and estimated timeline for each.
b. What are the clinical manifestations (signs/symptoms) for each phase of AKI? How are these s/s for each phase of AKI related to the patho of the condition?
c. Explain the changes to the following labs in the oliguric phase of AKI: BUN, creatinine, GFR, creatinine clearance, potassium, magnesium, phosphorus, calcium, sodium, pH.
d. Explain why the following nursing management is necessary in AKI, what assessments for each should be completed, and what are the expected nursing and collaborative interventions for each?
i. Nutrition
ii. Fluids and electrolytes
iii. Metabolic rate
iv. Pulmonary function
v. Infection prevention
vi. Skin care
Learning Objective #3: Explain the pathophysiology, clinical manifestations, medical management, and nursing management for patients with chronic kidney disease.
a. What are the stages of CKD?
b. What are the main treatments in early-stage CKD? Why?
c. Why does ESKD affect all body systems?
d. Explain the changes to the following labs in the ESKD: BUN, creatinine, GFR, creatinine clearance, potassium, magnesium, phosphorus, calcium, sodium, pH.
e. What are the signs/symptoms and nursing/collaborative interventions for the following pathologic changes in ESKD?
i. Activation of the RAAS system
ii. Reduced urea excretion and decreased bicarb reabsorption
iii. Inadequate erythropoietin excretion
iv. Hyperphosphatemia, hypocalcemia, and decreased Vit D synthesis
v. Hyperkalemia and hypermagnesemia
Learning Objective #4: Compare and contrast the renal replacement therapies, including hemodialysis, peritoneal dialysis, continuous renal replacement therapies.
a. What is the purpose of dialysis, regardless of type?
b. What acts as the semi-permeable membrane in hemodialysis vs. peritoneal dialysis?
c. What is a continuous renal replacement therapy, and when is it a preferred dialysis treatment?
d. Differentiate between temporary and permanent dialysis access. When is a temporary access used?
e. What is the difference between a hemodialysis fistula vs graft?
f. Differentiate the permanent dialysis access of hemodialysis vs. peritoneal dialysis.
Learning Objective #5: Identify the nursing management of the patient on hemodialysis.
a. What are the nursing considerations for a temporary dialysis access?
b. What are the nursing assessments and interventions for a hemodialysis fistula and graft?
c. What are the side effects of hemodialysis, and why do these occur?
d. What is the nursing/collaborative assessments and interventions for the following HD complications:
i. hypotension
ii. exsanguination
iii. dysrhythmias
iv. disequilibrium syndrome
Learning Objective #6: Identify the nursing management of the patient on peritoneal dialysis.
a. What are the nursing assessments and interventions for a peritoneal dialysis catheter?
b. Explain the phases of a peritoneal dialysis exchange, including the differences between AIPD, CAPD, and CCPD.
c. Explain the pre-, intra-, and post-PD (including patient education) nursing assessments/interventions and rationales for each.
d. Identify the signs/symptoms and management of the following PD complications
i. Peritonitis
ii. Exit site infections
iii. Catheter leakage
Learning Objective #7: Develop a perioperative plan of nursing care for the patient undergoing kidney transplantation.
Conditions to Know: UTIs, Nephrolithiasis (Kidney Stones)
1. What are some risk factors for the development of UTIs? See Chart 49-2.
2. What are some factors that contribute to the development of UTIs in older adults?
3. What are the signs and symptoms of a UTI?
4. How are UTIs diagnosed?
5. How are UTIs treated?
6. Describe the nursing interventions that are necessary when caring for a patient with a UTI.
7. What are some teaching points you would want to include in your patient education regarding the prevention of UTIs? See Chart 49-5.
8. What are some clinical manifestations of kidney stones?
9. What are the goals of management for a patient diagnosed with a kidney stone?
10. Describe the nursing care necessary when caring for a patient with a kidney stone.
11. If a patient is unable to pass a stone on their own, what other procedures or surgical interventions may be necessary to eradicate the stone?
12. What are some teaching points you would want to include in your patient education regarding the prevention of kidney stones? See Chart 49-12.
Conditions to Know: BPH, Prostate Cancer
1. What is BPH and what are some risk factors for the development of this condition?
2. What are some signs and symptoms associated with BPH?
3. How is BPH diagnosed?
4. Describe the medications used to help treat symptoms of BPH ? mechanism of action, adverse effects, & patient teaching points for alpha-adrenergic blockers (tamsulosin) & 5-alpha-reductase inhibitors (finasteride).
5. What is a TURP procedure and how does it help manage BPH?
6. Describe the nursing responsibilities necessary when caring for a patient connected to continuous bladder irrigation (CBI) following a TURP procedure.
7. What post-op education points are important to include in your teaching for a patient following a TURP/CBI?
8. What are some risk factors for the development of prostate cancer?
9. Prostate cancer in early stages rarely produces symptoms. What are some clinical manifestations that may be seen that may indicate progressive (metastasis) prostate cancer?
10. How is prostate cancer diagnosed?
